It isn't just the physical infratructure of our District Health Boards requiring serious investment, but information technology infrastructure as well, according to a new asset management stocktake of the sector.
Report number one of the National Asset Management Programme for district health boards, released this morning, found that DHBs had been maintaining their IT assets "in an environment of accumulated underinvestment".
"Audits have shown that IT strategy, governance and asset management have operated at a basic level," the report said.
"There are multiple versions and customisations of core applications, ageing infrastructure, limited network capacity and devices not fit for purpose."
This reduced productivity, increased costs for maintenance and support as well as increasing cyber security risk.
"Further, the slow adoption of systems compliant with national data standards limits information sharing across clinical settings and with consumers," the report said.
"Consequently, system users resort to various ‘workarounds’ to overcome lack of access, multiple logins, poor response times and the lack of alignment with clinical workflows."
As a result, the productivity and quality benefits of clinical IT systems were not being realised.
Data from a 2019 DHB digital systems landscape survey showed approximately 21 core applications in DHBs, including FMIS, inventory, payroll, core patient administration and clinical and laboratory applications.
Half of the 20 DHB core FMIS systems were assesed as poor while two ptient administration systems (at Auckland DHB and Southern DHB), were assessed as very poor.
Four DHBs also had very poor clinical support systems.
There were many other applications and various interfaces, but even so, many elements of patient records remained paper-based, particularly at the bedside and treatment bay.
"Systems need to be expertly designed and configured to support the workflow," the report found. "Implementation requires significant change management and deployment of large numbers of devices to capture all record-keeping on-the-move for health professionals."
However, health IT was likely to move to a 40:60 percent split between capital investment and operating expenditure as DHBs adopted "as a service" solutions.
This will enable DHBs to move away from reactive management of complex technology environments, to the development of IT solutions as enablers for the clinical workflow, improved data analytics and new models of care."
Modernising technology solutions will also reduce the costs associated with maintaining the diverse skill-base required in the current mix of legacy and newer technologies.
An IT business impact review was completed by Hutt Valley DHB in 2018 that revealed an 800 per cent growth in applications, mostly in clinical areas, in little over a decade, thestocktake highlighted.
"The growth included high dependency on Wi-Fi and mobile phones with applications seen as critical to service delivery and patient safety.
"The implications for IT management include: significant cyber security risks; requirements to support both legacy and new technologies; and the need for staff to have a diverse range of technology skills.
"This complexity focuses effort on maintenance rather than on IT as an enabler of workflows and new models of care."
Another review in the same year in the Northern Region, found over 1200 applications across four DHBs, yet only 10 per cent of these appeared to be up to date, with the rest obsolete or becoming obsolete.
"Application lifecycles were poorly managed, deployment was not responsive to the business and there was a lack of automated application testing," the stocktake found.
An explosion in demand exacerbated the problems with bespoke and department-specific systems that are widespread due to the role of senior medical staff as primary influencers in purchasing IT and clinical equipment related to their own area of specialty.
"The result can be a complex siloed environment with limited data sharing which is expensive to maintain over the lifecycle of the assets," the report found.
This was then contributing to a lack of investment in the IT infrastructure necessary to keep pace with this clinical demand for applications, devices and network capacity and a "lack of attention to and funding for IT implementation, including clinical process standardisation, comprehensive design of application configurations and the change management important for an integrated organisational approach to IT investment."
Releasing the report, the Ministry of Health said it was is working with DHBs, who are responsible for maintaining and renewing their assets, to address issues raised in the report.
"This includes reviewing DHB asset management plans and following up on remediation issues identified in the report, raising issues in DHB performance and monitoring conversations, and developing an asset risk, assurance and monitoring framework," the Ministry said.